支气管肺泡灌洗液或血清半乳甘露聚糖诊断肝衰竭合并侵袭性肺曲霉菌病的价值  

Value of bronchoalveolar lavage fluid galactomannan and serum galactomannan in diagnosing invasive pulmonary aspergilosis in patients with liver failure

作　　者：张莹 张军昌 牟劲松 ZHANG Ying;ZHANG Junchang;MU Jinsong(Department of Infectious Disease,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038;Intensive Care Unit,the Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039)

机构地区：[1]首都医科大学附属北京世纪坛医院感染科,北京100038 [2]中国人民解放军总医院第五医学中心重症医学科,北京100039

出　　处：《郑州大学学报（医学版）》2023年第3期429-432,共4页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:探讨支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)与血清GM对肝衰竭合并侵袭性肺曲霉菌病(IPA)的诊断价值。方法:共纳入肝衰竭合并IPA患者34例(研究组),同期肝衰竭合并肺部感染(非IPA)患者55例(对照组),所有患者均进行血清GM、BALF-GM试验及病原菌培养。结果:研究组BALF-GM和血清GM水平均高于对照组(P均<0.001)。BALF-GM用于诊断IPA的ROC曲线下面积(95%CI)为0.845(0.758~0.932),最佳诊断界值为0.745,敏感度为0.706,特异度为0.909,约登指数为0.615;血清GM用于诊断IPA的ROC曲线下面积(95%CI)为0.820(0.730~0.909),最佳诊断界值为0.560,敏感度为0.618,特异度为0.927,约登指数为0.545。BALF-GM和血清GM的诊断效能差异无统计学意义(P=0.695)。结论:BALF-GM和血清GM对肝衰竭合并IPA均具有较高的诊断效能。Aim:To investigate the value of bronchoalveolar lavage fluid(BALF)galactomannan(GM)and serum GM in the early diagnosis of invasive pulmonary aspergilosis(IPA)in patients with liver failure.Methods:Thirty-four patients with liver failure complicated with IPA(the study group),and 55 patients with liver failure complicated with non-IPA pneumonia(control group)were enrolled.All patients underwent serum GM test,BALF-GM test and pathogen culture.Results:The levels of BALF-GM and serum GM in the study group were significantly higher than those in control group(P<0.001).The area under ROC curve[AUC(95%CI)]of BALF-GM for diagnosis of IPA was 0.845(0.758-0.932),the optimal diagnostic threshold was 0.745,and the sensitivity,specificity and the Youden index were 0.706,0.909 and 0.615,respectively.The area under ROC curve[AUC(95%CI)]of serum GM for diagnosis of IPA was 0.820(0.730-0.909),the optimal diagnostic threshold was 0.560,with a sensitivity of 0.618,specificity of 0.927,and Youden index of 0.545.The diagnostic efficiency of BALF-GM and that of serum GM had no significant difference(P=0.695).Conclusion:Both BALF-GM and serum GM have higher efficiency for the diagnosis of IPA in patients with liver failure.

关 键 词：侵袭性肺曲霉菌病 肝衰竭 半乳甘露聚糖 血清 支气管肺泡灌洗液 

分 类 号：R519.8[医药卫生—内科学]